letter regarding a PCN and explaining a related emergency

Unfortunately the below letter was refused and deemed not sufficient to open a review on the case!



To whom it may concern,

I’m writing to request a review of the refusal of appeal for case number xxxxx. The following is a copy of the reasons for refusal:

“Adjudicator’s Reasons

The Apellant said that he stopped in an emergency to unblock his catheter. The Authority rejected the representations, pointing out that somebody boarded the vehicle.

The Appellant appealed, he added that he was picking up a specialist carer.

The Appellant did not explain why he could not have found a lawful parking place to clear his catheter. He has not explained the co-incidence that he stopped in an emergency (i.e. no choice as to the location) but at the same time picked up a passenger. When one views the CCTV recording, one can see that the passenger walked towards the Appellant’s vehicle when it pulled up but instead of boarding the vehicle straightaway, especially when there was supposed to be an emergency for which her assistance would have been valuable, she stayed on the pavement attracting the attention of passers  by and engaging in conversation with them. This did not fit with the account.

I am not satisfied that there was an emergency situation. I am refusing the appeal.

Mr A Non



In response to this explanation I would like to firstly concede that there was not sufficient explanation provided in my appeal. It is a complex situation and a significant amount of explanation is required.

Tetraplegia is a medical term describing the health condition of someone living with paralysis that affects all four limbs. A significantly risky feature of tetraplegia is called autonomic dysreflexia which results in heightened blood pressure occurring very fast which is not self-regulating and can lead to aneurysms and other blood pressure related injuries. Most tetraplegics carry Infedipine, a medication that can be used to regulate BP in these situations to avoid associated health risks (although when taken can result in a side-effect of significant headaches). One of the most common triggers of autonomic dysreflexia is the blocking of indwelling catheters, this can  be due to a buildup of calcium -related sediment within the catheter. Due to the lack of weight-bearing in tetraplegics experiencing paralysis, reduction of bone density via decalcification results in extra sediment being passed in the urine and can result in regular catheter blockages. As stated earlier if these are not rectified quickly via a bladder washout or catheter change, the tetraplegics can experience autonomic dysreflexia and dangerously high blood pressure levels in a very short period of time (a matter of minutes).

The above description of the condition and related side effects should be sufficient to explain the emergency experienced and the need to stop immediately. As I am unable to detect the level of urine inside my bladder, when the catheter blocks it is impossible to detect immediately and only when the pressure inside the bladder results in the triggering of autonomic dysreflexia  manifesting itself in sweating, skin redness and intense migraines am I able to detect that something is wrong.

As a result of my complex medical condition and inability to use any of my limbs I’m attended by two live-in carers 24-hours a day. These carers are trained by a specialist agency to deal with health concerns of a person with a spinal injury. On the day in question I was travelling with a single carer and my wife in my car after having dropped off a carer at her chosen destination and was en route to pick up her replacement. The catheter blockage occurred close to our destination but before we could find a suitable parking place, hence the emergency stop. The carer already inside the vehicle had already started to perform the procedure of a bladder washout and my wife contacted the carer waiting to be picked up to inform her of our location. The carer awaiting pickup walked to our car and waited as we finished the required procedure (which can be safely performed by a single trained person).

It should be understood that although the consequences of mishandling such an emergency situation are great it unfortunately is not an uncommon occurrence and as such it is often rectified in a calm manner by a single individual. Such an event does not necessitate everyone associated behaving in a panicked manner. In fact it is desirable for those nearby to behave normally.


Many thanks for your understanding.

Yours sincerely


Tom Nabarro

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